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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m It m ; o <br /> APPLICATION FOR - LAND USE - PERMITS <br /> m 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work describ ad and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Lard Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. w m <br /> m <br /> c <br /> OWNER TELEPHONE M 4P._ 4-12 <br /> o E <br /> ADDRESSo <br /> S S L 5 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 51. /° <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR 0204D=S <br /> f� 1� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING -1111l AGE/ CESSORY STRUCTURE ADDITION <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ? 0 , R <br /> STRUCTURE/ADDITION USE: - a <br /> (go—me/Cabin;C merciai Business;Bedroom;Deck;etc.) Z <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location of the well (yi),septic tank (ST),and drainflaid (DF). g <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)I wilding <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sig ed and <br /> dated by the owner. C) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. <br /> in a N <br /> PLOT PLAN / ? <br /> 3�rGr�4 j .��CC (1 (L � o <br /> P <br /> S IMII V U <br /> U3 <br /> V7 <br /> Pso posiE � <br /> c m <br /> @� <br /> K , L,L/ 9 m <br /> 30 0 <br /> yf I t <br /> 77 <br /> � D <br /> Y � <br /> yn £ <br /> 2. Mm <br /> CONDITIONS CONDITIONS OF PERMIT: �N`x71J �1C.c ' �w' ? 8 g(8 <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a E 0; <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =to i M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. j1 N i m <br /> 9j' te . ' C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o ; g : <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa- r: N m N; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- iB p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ; <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized persc n to have ? O[ 0E <br /> access to the above described premise$at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE _0/4 <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR 1' - <br /> - NN�+NMN� TI <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> 8888888 ca <br />